Raising a stink about global sanitation

By Florence Davey-Attlee, for CNN

Updated 10:51 AM ET, Mon November 19, 2012

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World Toilet Day 2012 – Sandimhia Renato in Mozambique is one of an estimated 2.5 billion people worldwide who lack access to adequate sanitation. Without sufficient toilets, Sandhimhia has to leave the village and cross this bridge to find a discrete place to defecate amongst the bushes.

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This year, international aid agencies are highlighting the particular risk to women of a lack of access to toilets. Sandhimia knows women who have been sexually attacked and killed making the same journey as her after dark.

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In many cultures, it is not acceptable for women to be seen going to use a toilet. Attempting to defecate in secrecy makes women more vulnerable to danger and attack. Patuma Mbande (pictured) in Malawi shares a communal latrine with 14 other people: "I use the toilet at night, but I worry because there is no path to the toilet, I worry that people will attack me. During the night the children are afraid to use the toilet so they go outside the house and I have to sweep it up and take it to the toilet."

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Lines Napolo shares a similar latrine in the same village. She says: "There is also no privacy, there are many holes, I have to use my chitenge and wrap it round the outside to get any privacy. People peep in, especially children. The toilet is on a pathway where a lot of people pass by, men often peep in when they go past."

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"Women and girls have particular sanitation needs when they are menstruating which are rarely discussed as menstruation remains a taboo in many cultures," explains Catarina de Albuquerque, the United Nations Special Rapporteur on the human right to safe drinking water and sanitation. The ability to engage in a wide variety of activities -- including gaining an education -- is restricted in areas that lack sanitation facilities which ensure women's privacy.

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Christine Mbabazi's son died of cholera. With nowhere else to go, most inhabitants of Kawempe, Uganda are forced to simply defecate on the ground among their houses. "During the rainy season the drains get flooded, the toilets get flooded - everything floods. The kids get diseases -- malaria, cholera, diarrhoea. They get sick because of the sanitation and hygiene situation," Mbabazi says.

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In Kawempe, the chairty WaterAid has constructed a number of Water, sanitation and hygiene (WASH) facilities including public toilets and drainage channels and is working to empower residents of the slum to demand services from government.

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Shamola Rani Mondol (center) in Dhaka, Bangladesh, is a local WASH committee member. All nine members of the committee are women who teach others in the community about hygiene. She says: "The men respect us more now. Nowadays when we go anywhere the men give us seats with honor and they say that the women are able to do lots of things. Now the men are happy with the women's work."

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Alo Rani Mondal in Dhaka, Bangladesh has been a hygiene educator for WaterAid for four years. "I visit the same houses and tell them the necessity of washing your hands and using shoes to go to the toilet. I tell them how many times and when they should wash their hands. I feel like people listen to me and I feel happy because they are listening to me," she says.

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Bashona Sharkar and her daughter Tithi live in Dhaka, Bangladesh. Bashona says that the improvement in sanitation has allowed her daughter to get an education: "Before this situation, I don't think I could send my child to this school. We used to spend lots of money on doctors because of the poor sanitation ... but now we can spend more money sending our children to school and college."

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Story highlights

World Toilet Day highlights plight of 2.5 billion people who don't have access to basic sanitation

Charity focusing on dangers for women who must defecate on open ground

The situation causes shame for millions and also leaves them open to attack

Lack of basic sanitation costs Africa $5.3 billion and India $53.8 billion according to World Bank

The humble lavatory is the unlikely subject of global celebration on Monday, as one of the world's most essential inventions but one that too many people still struggle without.

Although many of us tend to take ours for granted, campaigners hope that World Toilet Day 2012 will draw attention to what they're calling the "global sanitation crisis," with over a third of people worldwide living without a clean and private place to go.

This means that one in three people still have to defecate in the open, using fields or bushes, rivers, railway lines or roadsides, or simply a plastic bag. Others use unsanitary latrines or disease-ridden and foul-smelling buckets.

Ajara lives in a slum in the city of Gwalior in the Madhya Pradesh province of India. She told WaterAid how people in her community have to defecate on a nearby hilltop.

"There are no trees and privacy at the moment and so we have to wait until night to go there. It's difficult for old people to go and it's hard to go at night. It's also hard for grown-up girls because of the risk of sexual attack," Ajara said.

This World Toilet Day, international aid agencies are highlighting the particular risks to women of poor access to toilets. WaterAid says women are most vulnerable because they're not only exposed to disease, but also have additional shame, harassment and risk of attack when they go out in the open.

Sandimhia Renato in Mozambique described to WaterAid how she has to cross a very dangerous bridge every time she goes to the bush to defecate.

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"I think it takes 15 minutes to get to the bridge," Renato says. "I come here once a day, between 4 and 5 pm. At night it is very dangerous. People get killed. A woman and a boy were killed with knives. One woman I know of has been raped."

But it's not just the shame and inconvenience of having no private place to go to the toilet, but a huge public health issue.

When you consider that one gram of faeces can contain 10 million viruses, one million bacteria, one thousand parasite cysts and one hundred worm eggs (according to UNICEF) you can see why open defecation is so harmful to a community's health. Without a sewerage system to remove human waste and make it safe, cholera, typhoid and other infectious diseases spread quickly.

The United Nations says more than 2.7 million people die each year due to lack of sanitation. With diarrhoeal diseases killing more young children in developing countries than HIV/AIDS, malaria and measles put together, it's the second biggest cause of death in under fives, according to the World Health Organization.

Tackling it, says the World Bank's Water and Sanitation Program, is extremely cost effective. It estimates that poor sanitation costs African countries around $5.5 billion a year and $53.8 billion in India is lost through associated economic impacts.

The program's study of 18 African countries found that even the time it takes people to find a discrete location to use the toilet accounted for almost $500 million in economic losses. That's before you examine the cost of healthcare, premature deaths and lost workdays due to illness.

In fact, according to the World Toilet Day organization, every dollar invested in sanitation yields a return of five dollars. Its message is that the solution to the global sanitation crisis lies not in any miraculous technological breakthroughs but in stronger political leadership and a commitment to invest in sanitation infrastructure and education.

Mahatma Gandhi for one seemed to recognized the value of the toilet to humanity when he said "Sanitation is more important than independence." Campaigners for World Toilet Day will be hoping that these words resonate with today's leaders.